Human Resources
Prescription Drugs Benefits
All of the state of Iowa's health plans provide prescription drug coverage. Following is a brief summary of the prescription drug benefits for the state of Iowa's health insurance plans.
Deductible 3 Plus
Program 3 Plus
Iowa Select PPO
Blue Access
Blue Advantage
Side-by-Side Comparison
Additional Information and Resources
Vaccines at the Pharmacy , Specialty Drugs and General Prescription Drug Information can be found at the DAS Wellness Prescription Drugs Web site.
Deductible 3 Plus Plan
Your prescription drug benefits are covered on a “cash and carry basis.” This means that you pay the full cost of the prescription and are reimbursed for 80% of Wellmark’s allowed amount after you meet your deductible. If you use a participating pharmacist, the pharmacist will file the claim for you, which will result in lower out-of-pocket costs, and a quicker turnaround for reimbursement. If you do not go to a participating pharmacy, you will have to submit a paper claim to Wellmark and will be reimbursed at 80% after deductible of what Wellmark would have paid to a participating pharmacy.
Mail Order Prescription Drugs
A mail order prescription drug benefit is not available in the Deductible 3 Plus plan.
Out-of-Pocket Maximum
There is no separate prescription drug out-of-pocket for the Deductible 3 Plus plan. Prescription drugs copayments are applied to the medical out-of-pocket maximum - $600 (single)/$800 (family).
View the side-by-side comparison of the different health insurance prescription drug benefits.
Program 3 Plus and Iowa Select Plans
Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription until you reach your separate prescription drug out-of-pocket limit.
The amount of your copayment is determined by the drug that you receive. Copayment amounts are:
- $5.00 for preferred generic drugs
- $15.00 for preferred brand name drugs
- $30.00 for non preferred brand name and non preferred generic drugs
If a generic equivalent is appropriate and available and you choose a brand name drug, you are responsible for the copayment plus any difference between the maximum allowable fees for the generic and brand name drug, even if the provider has specified that the brand name drug must be taken. You will be required to pay this difference even after you have reached your separate prescription out-of-pocket limit.
Mail Order Prescription Drugs
You can save money and have the convenience of home delivery if you use mail order for your maintenance prescription drugs. You can receive up to a 90 day supply for just two copays instead of three by using mail order
Out-of-Pocket Maximum
There is a $250 (single)/$500 (family) out-of-pocket maximum for prescription drugs. This out-of-pocket maximum is separate from the medical out of pocket maximum.
View the side-by-side comparison of the different health insurance prescription drug benefits.
Blue Access
Blue Advantage
Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription.
The amount of your copayment is determined by the drug that you receive. Copayment amounts are:
- $5.00 for preferred generic drugs
- $15.00 for preferred brand name drugs
- $30.00 or 25% (whichever is higher) for non preferred brand name and non preferred generic drugs.
If you purchase a brand name drug when an FDA-approved generic equivalent is available, you are only responsible for the copay.
Mail Order Prescription Drugs
You can save money and have the convenience of home delivery if you use mail order for your maintenance prescription drugs. You can receive up to a 90 day supply for just two copays instead of three by using mail order
Out-of-Pocket Maximum
There is no separate prescription drug out-of-pocket. Prescription drug copayments do not apply to the medical out-of-pocket maximum.
Below is a side-by-side comparison of the different health insurance prescription drug benefits.
Side-by-Side Comparison of the Prescription Drugs Benefits
30-day Supply
Deductible 3 Plus |
Program 3 Plus Iowa Select |
Blue Access Blue Advantage |
|
| Preferred Generic | 20% after deductible |
$5.00 |
$5.00 |
| Preferred Brand | $15.00 |
$15.00 |
|
| Non-Preferred Brand Non-Preferred Generic |
$30.00 |
$30.00 or 25%* whichever is higher |
90-day Supply (Mail Order)
Deductible 3 Plus |
Program 3 Plus Iowa Select |
Blue Access Blue Advantage |
|
| Preferred Generic | Not Available |
$10.00 |
$10.00 |
| Preferred Brand | $30.00 |
$30.00 |
|
| Non-Preferred Brand Non-Preferred Generic |
$60.00 |
$60.00 |
Site updated 12/15/2008